National Provider Identifier

The National Provider Identifier (NPI) is the primary identifier that physician should use on all electronic and paper Medicare Fee-for-Service claims. By eliminate the need for physicians to have multiple identification numbers, the NPI is designed to improve the flow of information across various entities in the health care marketplace. Medicare claims that only include the legacy numbers will be rejected.

Do You Need An NPI?

Medicare and other health plans require enrolled physicians to obtain NPIs in order to participate. However, physicians that belong to a group practice may not need to get an NPI because the practice often functions as the covered health care provider (a covered entity under HIPAA). While such practices must obtain an NPI, the physician employees are not required by the NPI Final Rule to obtain NPIs. However, the group practice could require its physician employees to obtain NPIs in order to identify individuals as the rendering providers in the claims that the group submits. Also, if physicians prescribe medication, the pharmacies may require their NPIs in the claims that the pharmacies submit to health plans.

National Plan and Provider Enumeration System Data Dissemination Notice

The National Plan and Provider Enumeration System (NPPES) Data Dissemination Notice (PDF), which was published by CMS on May 30, 2007, describes Medicare's process for making certain NPPES health care provider data available to covered entities. Physicians and other health care providers were required to disclose NPPES data when applying for their NPIs. Last year, much of the NPPES data was made available to the public as required by the Freedom of Information Act. A few of the publicly available data points are listed below for your information.